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Supply chain management (SCM) is about fulfilling demand. Based on given estimates of future demand, SCM invests the appropriate resources and then uses these resources to match supply to demand. The traditional SCM perspective takes demand as exogenous. The goal of SCM is then to serve the forecasted or materialized demand effectively and efficiently. How difficult it is to achieve this goal depends on the characteristics of that demand. For example, serving a stable, predictable demand is relatively cheap whereas serving an unpredictable, strongly fluctuating demand may imply less efficient operations characterized by high inventory built-up and low capacity utilization. In the same way, demand characteristics impact not only the financial performance of the supply process but also its environmental impact. For example, satisfying demand for fresh produce during the harvesting season results in lower emissions than serving off-season demand which requires substantial storage and/or long-distance shipments from other growing regions.

Tendinopathies affecting the upper and lower extremity are a common musculoskeletal presentation to primary care health professionals, including allied health. The etiology of tendinopathies varies depending on the area affected and the condition can affect adolescents through to older adults. However, tendinopathies are generally considered to develop when tendon is unable to adapt to a changing load environment. Tendinopathies may also be precipitated by systemic issues such as diabetes and hyperlipidemia. Knowledge of the pathophysiology of tendinopathies is continuing to emerge and this research has led to exercise being identified as one of the first-line interventions for tendinopathies. Research, particularly for lower limb tendinopathies, suggests exercise rehabilitation programs should focus on progressive loading of the tendon and include exercises that address the isometric, eccentric, and concentric phases of a muscles’ contraction. There are a variety of exercises a patient experiencing tendinopathy can utilize regardless of the tendon affected. In the early stages, most of these exercises can be performed both in the clinical setting and at the home with little to no equipment. As the exercise management progresses, equipment may be required, however. This chapter overviews the literature on the epidemiology and pathophysiology of tendinopathies. Common exercise approaches are presented for each of the upper and lower extremity tendons commonly affected. These exercises are also readily accessible to the clinician with a working knowledge of exercise prescription principles.

Equally able students have lower academic self-concept in high achieving schools or classes, a phenomenon known as the big fish little pond effect (BFLPE). The class (more so than the school) has been shown to be the pivotal frame-of-reference for academic self-concept formation—a local dominance effect. However, many school systems worldwide employ forms of course-by-course tracking, thus exposing students to multiple class environments. Due to the high correlation between multiple student environments, the frame-of-reference used for academic self-concept formation in course-by-course tracked systems is unclear to date. We addressed this unresolved issue by using data from a comprehensive survey that measured the entire population of Austrian eighth-grade students in the domain of mathematics in 2012. General secondary school students were in the core subjects (i.e., mathematics, German, and English) grouped according to ability, whereas regular class composition was the same in all other subjects. Using cross-classified multilevel models, we regressed math self-concept on average math achievement of students’ school, math class, and regular class. Consistent with the local dominance effect, we found the BFLPE on the school level to be weak after controlling for the class levels. We found a stronger BFLPE on the regular class level and the strongest BFLPE on the math class level. Our study demonstrates the importance of multiple class environments as frames-of-reference for academic self-concept formation. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Introduction: Muscle energy technique (MET) is a therapeutic technique involving active muscle contraction by the patient. The selection of particular techniques by osteopaths is underexplored. The aim of the study was to explore the practice profile of those Australian osteopaths who use MET often in their practice compared to those who do not use the technique often. Methods: A secondary analysis of data collected from 922 participants by a practice-based research network (PBRN) for the Australian osteopathy profession was performed. Frequency of use of MET on a 4 point scale: never, rarely, sometimes, and often were binary coded as less often and often. Inferential statistics were used to explore the associations between individual practice characteristics and the frequency of MET use. Adjusted odds ratios (OR) with 95% confidence intervals (CI) and p-values were calculated from regression modelling. Results: Dichotomising participant responses resulted in less often (203, 20.5%) and often (788, 79.4%). There was a significantly greater proportion of male practitioners using MET compared to those practitioners who did not often use the technique (OR = 0.46; CI = 0.33, 0.63; p < 0.01). Australian osteopaths who often used MET were younger (36.3 vs 44.6 years old) and had fewer years in practice (9.9 vs 17.3 years) compared to osteopaths who used the technique less often. Conclusion: Osteopaths who reported that they often used MET were more likely to be male, often use counterstrain and more likely to use orthopaedic testing in patient examination. The study provides an insight into how Australian osteopaths practice, particularly their use of MET. Implications for practice: • When the responses of 922 Australian osteopaths who participated in a practice-based research network were dichotomized according to usage of MET, the majority reported they use MET frequently. • MET and counterstrain appear to be used in combination for musculoskeletal patient care by Australian osteopaths. • Australian osteopaths who reported often using MET were more likely to see patients for low back pain, perform orthopaedic testing, use neurological cranial nerve testing, and refer for diagnostic imaging. • The practice characteristics of osteopaths who use MET often compared to those who do not reveal insight into different practice styles within the osteopathic profession.

Background Visceral techniques have taken their place in the established osteopathic treatment approaches, however, very little research exists on their use in clinical settings in Australia. This study reports on the prevalence, enablers of and barriers to visceral technique use by registered osteopaths currently practising in Australia utilising a nationally representative database from the Osteopathy Research and Innovation Network (ORION). Methods The recruitment invitation pack for this study was distributed via email to the ORION database during July 2019. The study utilised a 27-item survey with both Likert scale and free text responses. All data were imported into the statistical software package SPSSTM 25 for descriptive statistical analysis. Results A total of 143 Australian osteopaths participated in the study representing a response rate of 14.4%. The participants reported a mean number of 16.1 years in practice, with 55.3% identifying as female and approximately 70% reporting as working from a metropolitan location. The majority of respondents (71.5%) reported using visceral techniques within the preceding 6 months, with 12.8% indicating that they had previously used visceral techniques in practice but had subsequently elected to stop using them. Key barriers identified by the study in relation to visceral technique usage related to practitioner knowledge, confidence and a perceived lack of support, while enablers were linked to perceived benefit in patient management and private payment. Conclusion This study provides an important step forward in our understanding of the current use of visceral techniques by the Australian osteopathic workforce. Further research is required to better understand practitioners’ rationale for including visceral techniques in practice, patient outcomes where visceral techniques are used, and the cost-effectiveness of their inclusion in patient care.

© 2020 Elsevier Ltd Case reports provide a valuable insight into osteopathic practice. They allow for the description of diagnoses, interventions and management strategies for complaints that present to practice. Although case reports are traditionally associated with descriptions of rare or unique cases, reports of more common presentations to osteopaths are exceptionally useful. The purpose of this Masterclass is to describe how to construct a case report for the journal, and many other medical journals. The Masterclass outlines how to use the Case Report (CARE) guidelines and provides examples from published case reports related to osteopathic practice. We hope that this Masterclass will encourage practitioners to consider publishing case reports to expand the professions’ evidence base and inform future research.

The study aimed to compare the characteristics of Australian osteopaths who definitely agree that prescribing scheduled medicines is part of their future scope of practice with those who do not. A secondary analysis of a cross-sectional survey of osteopaths from an Australian practice-based research network was undertaken. Demographic, practice and treatment characteristics were identified using inferential statistics and backward linear regression modelling. Over one-quarter (n=257, 25.9%) of the total participants (n=992) indicated that they 'definitely' agree that osteopaths should seek prescription rights. Adjusted odds ratios (OR) suggested these osteopaths were more likely to engage in medication discussions with patients (OR 1.88), frequently manage migraines (OR 1.68) and seek increased practice rights for referrals to medical specialists (OR 2.61) and diagnostic imaging (OR 2.79). Prescribing as part of the future scope of practice for Australian osteopaths is associated with patient management (medication discussions) and practice characteristics (increased referral rights for specialists and diagnostic imaging) that warrant additional investigation. Understanding of the practice, clinical and patient management characteristics of Australian osteopaths who see prescribing as part of the future scope of practice informs the case for regulatory and health policy changes for prescribing scheduled medicines.

BackgroundPain has been identified as a global health issue with substantial effects on individuals and society. Health professionals managing pain complaints must have appropriate knowledge of pain neurophysiology, and attitudes and beliefs towards pain management that align with current practice guidelines.ObjectivesEvaluate Australian osteopaths' current level of knowledge of pain neurophysiology and their beliefs and attitudes towards pain, and explore associations with demographic variables.MethodAustralian osteopaths drawn from a nationally representative practice-based research network received the questionnaire. The questionnaire included demographic information, Neurophysiology of Pain Questionnaire (NPQ), Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and the Attitudes to Back Pain Scale in Musculoskeletal Practitioners (ABS-mp).ResultsComplete responses were received from 211 osteopaths (21.3% response rate). The mean total NPQ score was equivalent to 72.2% correct responses. The PABS-PT Biomedical scale mean score was 38.8 ( ±9.1, α = 0.81) and the Biopsychosocial scale was 22.3 ( ±3.3, α = 0.38). ABS-mp mean factor scores suggest osteopaths support psychological approaches (22.1, ±3.3, α = 0.71) but endorsed more treatment sessions for those with back pain (15.9, ±4.7, α = 0.71). Trivial correlations between measures and most demographic variables were observed. Osteopaths who undertook further studies in pain had higher mean NPQ scores, with moderate negative correlations with a lower PABS-PT Biomedical subscale score (ρ = -0.45, p ConclusionsAustralian osteopaths demonstrate a range of pain neurophysiology knowledge, and beliefs and attitudes towards pain. The findings support the positive impact of professional development for improving pain knowledge in this population.

© 2020 Objectives: To explore the practice characteristics of the Australian osteopathy workforce who reported using visceral techniques ‘often’. Design: Secondary analysis of a cross-sectional survey of 991 osteopaths. Setting: The Osteopathy Research and Innovation Network (ORION), an Australian practice-based research network. Participants: Australian osteopaths participating in ORION. Outcome measures: Demographic, practice and treatment characteristics of osteopaths who ‘often’ use visceral techniques in patient care. Results: Ninety-eight osteopaths (9.9%) of the ORION sample (n = 991) ‘often’ use visceral techniques in patient care. Those osteopaths who ‘often’ use visceral techniques were more likely to engage in referrals with acupuncturists (send referrals: odds ratio (OR) 2.58; received referrals: OR 2.57). These practitioners were also more likely to treat non-musculoskeletal complaints (OR 11.12) and use lymphatic pump techniques (OR 18.07). Research to inform patient care was also more likely to be seen as important by those osteopaths ‘often’ using visceral techniques compared to osteopaths who reported using visceral techniques ‘never’, ‘rarely’ and ‘sometimes’ (OR 2.63). Conclusions: Several practice characteristics are associated with Australian osteopaths ‘often’ using visceral techniques. Further work is now required to understand patient presentations where visceral techniques are used, the clinical reasoning for their use, and exploration of the effectiveness of these techniques in patient care.

The valence band edge in tiny angle twist bilayers of MoS$_2$ and phosphorene is shown to consist of highly localized energy levels created by a `moir\'e quantum well', i.e. trapped by the interlayer moir\'e potential. These approximately uniformly spaced energy levels exhibit a richly modulated charge density, becoming ultra-localized at the valence band maximum. The number and spacing of such levels is controllable by the twist angle and interlayer interaction strength, suggesting the possibility of `moir\'e engineering' ordered arrays of quantum dots in 2d twist semi-conductors.

While a typical material exhibits field induced currents only at the boundary, a uniform out-of-plane magnetic field applied to two mutually rotated layers of graphene is shown to result in an ordered array of permanent current loops throughout the material. Each current loop consists of an interlayer current flowing through the open AA stacked regions of the moir\'e created by rotation, which then flows back through the neighboring AB regions to form a circuit, with significant current strength even at small fields. Similar moir\'e ordered arrays of current loops are also shown to exist in non-equilibrium transport states, where they manifest as current back flowing against the applied bias in the device. Such current loops thus represent an intrinsic feature of the twist bilayer in conditions of broken time reversal symmetry, and exist both as a low field imprint of the moir\'e lattice on Landau physics, and as measurable moir\'e scale current configurations in transport states.

We demonstrate that there exists a continuum Hamiltonian $H(\bf{r},\bf{p})$ that is formally the operator equivalent of the general tight-binding method, inheriting the associativity and Hermiticity of the latter operator. This provides a powerful and controlled method of obtaining effective Hamiltonians via Taylor expansion with respect to momentum and, optionally, deformation fields. In particular, for fundamentally non-perturbative defects, such as twist faults and partial dislocations, the method allows the deformation field to be retained to all orders, providing an efficient scheme for the generation of transparent and compact Hamiltonians for such defects. We apply the method to a survey of incommensurate physics in twist bilayers of graphene, graphdiyne, MoS$_2$, and phosphorene. For graphene we are able to reproduce the `reflected Dirac cones' of the $30^\circ$ quasi-crystalline bilayer found in a recent ARPES experiment, and show it is an example of a more general phenomena of coupling by the moir\'e momentum. We show that incommensurate physics is governed by the decay of the interlayer interaction on the scale of the single layer reciprocal lattices, and demonstrate that if this is slow incommensurate scattering effects lead to very rapid broadening of band manifolds as the twist angle is tuned through commensurate values., Comment: 16 pages

OBJECTIVES: To investigate if favourable psychosocial working conditions can reduce the risk of work exit and specifically for workers with chronic disease.METHODS: Men and women (32%) aged 35-55, working and having no chronic disease at baseline of the Whitehall II study of London-based civil servants were selected (n=9040). We observed participants' exit from work through retirement, health-related exit and unemployment, new diagnosis of chronic disease (ie, coronary heart disease, diabetes, stroke and cancer) and their psychosocial working conditions in midlife. Using cause-specific Cox models, we examined the association of chronic disease and favourable psychosocial working conditions and their interaction, with the three types of work exit. We adjusted for gender, occupational grade, educational level, remaining in civil service, spouse's employment status and mental health.RESULTS: Chronic disease significantly increased the risk of any type of work exit (HR 1.27) and specifically the risk of health-related exit (HR 2.42). High skill discretion in midlife reduced the risk of any type of work exit (HR 0.90), retirement (HR 0.91) and health-related exit (HR 0.68). High work social support in midlife decreased the risk of health-related exit (HR 0.79) and unemployment (HR 0.71). Favourable psychosocial working conditions in midlife did not attenuate the association between chronic disease and work exit significantly.CONCLUSIONS: The chronically ill have increased risks of work exit, especially through health-related exit routes. Chronic disease is an obstacle to extended working lives. Favourable working conditions directly relate to reduced risks of work exit.